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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOJ*oT23 <br />A, (612) 473-N1 <br />Owner <br />e <br />Contractor <br />City License No. <br />�tyQr� Address <br />_0" • Address <br />REMARKS AND SPECIAL. CONDITIONS <br />PERMIT TYPE AND Fh:E--.: Q(J NEW El ADDITION <br />Inside Plumbing ( # fixtures , I` Fee S <br />Water Meter (Sized Fee S-EaLS�� <br />Meter # 3olQ 3L-2gL <br />Remote # /an35'el77 <br />Municipal WiterConnection Fee S <br />❑Copper ❑ <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ cast Q_ <br />MWC'(' SA(' ('harge Fee S_ <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of all special information, <br />terms, conditions or requirements written above. The <br />undersigned undemtands and agrees under penalty of law <br />that this permit is strictly Limited in scope to the work, <br />activity or improvement specified, that this permit does <br />not grant any authority to do work or activities requiring <br />separate pemiil appru%als: and that this permit does not <br />grant authority to violate any Provision of anv City <br />ordinance or Stale law, rule or regulation. .Ali work shall be <br />dome in strict compliance with all City ordinances, building <br />codes and/or health department regulations, and shall be <br />subject to inspection, appy val or rejection by the City. <br />Whenever so ordered, the undersigned agrees in correct <br />any work found to he in cuilation of the conditions of <br />this permit. <br />Signatue of Applin n----._--- <br />(utak Whit- I de ('opy Canary Intpet tot's (opy <br />CITY PE-RNIIT NO. 6791 <br />Date -- q--1 — <br />State License No. <br />❑ REPAIR <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Other: <br />After -the -fact Investigation <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S <br />Fee $ <br />Fee $ <br />Fee $ <br />Fee S <br />Fee $ <br />Fee S <br />Fee $ <br />Fee 5 7560 <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Pink I dunce ( op5 f,uid Appitt,tni'v Receipt <br />